Caribbean chikungunya cases approach 750,000

The number of chikungunya cases in the Caribbean and surrounding areas continues to grow, with 9,006 new cases bringing the outbreak total to 747,721, the Pan American Health Organization (PAHO) reported late last week.

Colombia reported the largest increase, with 3,347 new cases (from 1,350 to 4,697), followed by Martinique, with 2,390 new cases; Puerto Rico, with 1,166; and Guadeloupe, 880.

The Dominican Republic, which has led in outbreak cases for many recent weeks, did not report any new data for the most recent week, so the actual growth might be much more dramatic. So far that country has accounted for 486,390 chikungunya infections, or almost two thirds of all cases in the outbreak.

The proportion of cases that are laboratory confirmed remains small. So far only 10,637 of the outbreak cases are confirmed, or about 1.4%. The rest are suspected cases.

Also, local media often report higher numbers than PAHO does. The Jamaica Observer, for example, today reported that the country has 35 confirmed and more than 300 suspected cases. PAHO reports 28 and 194, respectively.

The story notes that cost may play a role in not having patients tested for a disease that has no known treatment. It said lab tests range from $32 to $71 (US), which can be a barrier.

In related news, the European Centre for Disease Prevention and Control (ECDC) said in a Sep 26 report that Bermuda has reported its first case of locally transmitted chikungunya, a fact not yet noted by PAHO.Sep 26 PAHO update Sep 29 Jamaica Observerstory Sep 26 ECDC report

In the United States, imported chikungunya cases climbed to 1,114 last week, an increase of 71 cases over the previous week, the Centers for Disease Control and Prevention (CDC) reported. And locally transmitted cases grew from 9 to 11, all in Florida.

In addition, Puerto Rico has confirmed 442 cases, up from 303, and the US Virgin Islands has had 50, up from 29. The vast majority in those territories have been locally acquired.Sep 23 CDC update

Saudi Arabia reports another MERS case in Taif

Saudi Arabia reported another MERS-CoV case yesterday, its 11th one this month and the fifth in the city of Taif in Mecca province.

The case involves a 40-year-old man who is an expatriate healthcare worker, according to the Saudi Ministry of Health (MOH). He has a preexisting disease and is being treated in an intensive care unit. He had no recent animal exposures.

The case extends a string of MERS-CoV (Middle East respiratory syndrome coronavirus) infections in Taif that began with a case reported Sep 12. The first three cases, reported Sep 12, 17, and 19, involved Saudi men who were not health workers, but the fourth illness was in an expatriate health worker.

With the latest case, Saudi Arabia's MERS count has reached 753, including 319 deaths. Eight patients are still being treated, and 426 have recovered, the MOH said.

Today the MOH reported the death of a patient whose MERS case was reported previously, a 38-year-old Saudi woman in Riyadh. She was not a healthcare worker. In addition, the ministry reported the recovery of an expatriate male health worker, age 34, in Jubail. Sep 28 MOH statement Sep 29 MOH statement

WHO: 15 measles-vaccine deaths in Syria caused by incorrect drug

After assessing the cause of death of 15 children in rural northern Syria during a recent measles vaccination campaign, the World Health Organization (WHO) said in a Sep 27 statement that the fatalities were caused by mistaken use of a muscle relaxant, as reported earlier by a WHO spokesman.

The agency said that, based on "interim findings," the drug atracurium was incorrectly used to dilute the vaccine, and those lots were distributed to four vaccination teams. "There is no evidence that the Measles/Rubella vaccine itself or its correct diluent were the cause of this tragic event," the WHO said in the statement.

A team of experts trained in the investigation and management of adverse immunization-related events carried out the WHO assessment, the agency said.Sep 27 WHOstatement

HHS awards contract for drug to combat 'cytokine storm'

The Department of Health and Human Services (HHS) has awarded Atox Bio of Israel up to $23.9 million to develop a drug candidate that modulates the inflammatory response and may combat a complication of severe infections known as a "cytokine storm," HHS said in a news release today.

The drug, called AB103, might be used to treat "flesh-eating" bacteria and potential bioterror diseases such as plague. It modulates the body's cytokine response without repressing the normal immune response, HHS said in the release.

Cytokines, chemicals produced by the body, modulate inflammatory and immune responses to infection. In severe infections caused by Streptococcus pyogenes, called the "flesh-eating" bacterium, the immune system can launch an overwhelming reaction, or cytokine storm, that can cause tissue and organ damage and even death.

One condition the drug might be able to counter is sepsis, which might or might not be associated with a cytokine storm, HHS said. Sepsis can occur with several diseases, including plague and tularemia, avian flu, bacterial pneumonia, and infection with multi-drug resistant bacteria.

HHS will support advanced development of AB103 under a 1.5-year, $4.4 million contract. If all options are exercised, the contract could be extended up to an additional 3 years and could total $23.9 million. HHS's Biomedical Advanced Research and Development Authority (BARDA) will oversee the project.

"Novel, host directed therapies like AB103 that target the immune system can help us address unmet medical needs such as necrotizing fasciitis, a severe skin and soft tissue infection," said BARDA Director Robin Robinson, PhD. "AB103 illustrates one of several approaches that BARDA is supporting as part of President Obama's new initiative to combat antimicrobial resistance."Sep 29 HHS news release